Heparin Insensitivity and Thrombotic Risk Associated With Sequential Uses of Prothrombin Complex Concentrate and Andexanet Alfa for Apixaban Reversal During Acute Type A Aortic Dissection Repair: A Case Report.

IF 0.5

A&A Practice Pub Date : 2022-11-01 DOI:10.1213/XAA.0000000000001636

Brian Brenner, Jessica Guerra, Campbell Williams, Keith Littlewood, John Kern, Kenichi Tanaka, John S McNeil, Venkat Mangunta

引用次数: 1

Abstract

The management of patients on direct oral anticoagulants (DOACs) who require emergent cardiac surgery is slowly evolving. The introduction of andexanet alfa, a novel antidote for apixaban and rivaroxaban, added a specific reversal agent to our armamentarium, but its safety and efficacy are still being investigated. We report 2 patients on DOAC treatment who required emergency cardiac surgery. Both received perioperative andexanet alfa together with prothrombin complex concentrate (PCC) at some time during 6 hours before operative management. Heparin resistance was noted in each instance, and pump thrombosis developed in 1 case.

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急性A型主动脉夹层修复期间连续使用凝血酶原复合物浓缩物和anddexanet用于阿哌沙班逆转与肝素不敏感和血栓形成风险相关:一例报告。

需要紧急心脏手术的直接口服抗凝剂(DOACs)患者的管理正在缓慢发展。阿哌沙班和利伐沙班的一种新型解毒剂andexanet alfa的引入，为我们的医疗设备增加了一种特定的逆转剂，但其安全性和有效性仍在研究中。我们报告2例接受DOAC治疗的患者需要紧急心脏手术。两例患者均在手术前6小时的某个时间接受围手术期和右沙奈联合凝血酶原复合物浓缩物(PCC)治疗。所有病例均出现肝素耐药，1例发生泵血栓形成。

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A&A Practice ANESTHESIOLOGY-

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期刊介绍： A & A Case Reports, our new online journal publishing Case Reports, related Editorial Commentary, and Correspondence. Anesthesia & Analgesia 1 and Anesthesiology 2 recently announced that they were suspending publication of Case Reports. One reason is that Case Reports typically reduce the Impact Factor of a journal because they are rarely cited. Regardless of the merits of Impact Factor as a metric of journal worth, journals and their editors necessarily consider Impact Factor in strategic planning. At the same time, Case Reports are appreciated by readers for describing “real life” management of difficult or unusual cases not often encountered by practitioners. In a recent issue of Anesthesia & Analgesia, Steven Shafer1 identified many Case Reports whose publication launched productive careers dedicated to solving the puzzle posed by an unusual observation in a single patient.